Promoting reflection on bioethics and research ethics issues in Sub-Saharan Africa

Tuesday, October 25, 2005

Contemporary American bioethics: a cautionary tale?

Daniel Callahan, co-founder of the Hastings Center, was present at the birth of bioethics in America and has been an articulate witness to its evolution. So it is with some authority that Callahan speaks of a crisis in contemporary American bioethics.

In a recent article in the Cambridge Quarterly of Health Care Ethics (‘Bioethics and the culture wars’), Callahan claims that bioethical discussion in the United States has degenerated into a clash of opposing ‘liberal’ and ‘conservative’ camps, with each side using bioethics to aggressively push its own political agenda. The recent case of Terri Schiavo and the heated debates on stem cell research have clearly demonstrated that bioethics is now a favored field of battle for the American culture war. Instead of bioethical thinkers, Callahan states, you increasingly see bioethics advocates for liberal and conservative positions. Instead of reasoned debates characterized by the usual give and take, there are shouting matches or a priori rejection of one’s ideological enemies. Callahan deems this recent development unhealthy, and says it could be the undoing of American bioethics altogether.

As bioethics is increasingly being taught and practiced globally, close attention should be paid to the current American situation. If American bioethics has (rightly or wrongly) stood for decades as example of what bioethics can and should be, it may now be providing important lessons about what bioethics worldwide should try to avoid.

To this end, it would be instructive to have a story explaining how American bioethics got to where it is today. Callahan goes some way in providing one. Interestingly, the story he suggests has a dominant theme: the crisis in American bioethics is due to it having been seduced, in four different ways, by power.

Seduction #1: policy formation. When bioethicists are invited to contribute to the formation of health policy – especially by sitting on national commissions – the sudden gain in social usefulness comes with a price. To be truly useful in a policy forming setting, bioethicists must rationalize concrete policy recommendations, rather than providing elaborate analyses or theoretical niceties.

Seduction #2: the media. The media love the provocative topics which are standard fare within bioethics, but the media also want from bioethicists clear moral judgments in the form of sound-bites, not sophistication and nuance.

Seduction #3: political activism. Over the last decades, there seems to be a growing sense in America that the task of bioethics is to change the world, not to study it. The line is thin, however, between politically engaged bioethics and the mere deployment of bioethics to defend a political ideology and attack those of others.

Seduction #4: biotechnology firms and research institutions. Decades ago, many bioethicists used to take a critical stance towards the science industry, but this venerable tradition has waned in the last years. Perhaps it is due to the high regard that scientific progress has within a ‘liberal bioethics’ mindset, or perhaps it is due to the increasing number of bioethicists who sit on the ethics committees of drug companies, or perhaps it is due to the fact that some bioethics centers receive funding from ‘big pharma’. In any case, bioethics may gain social prestige and economic support by aligning itself with powerful scientific institutions, but go from watchdog to lapdog in the process.

The moral of the story: bioethics, no matter where it is practiced, should be careful who it gets into bed with. But can bioethics in developing countries reasonably avoid such seductions, while at the same time becoming a positive social force?

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